機器人輔助膀胱憩室切除術:案例報告
陳俐臻1、林文榮1、陳建志1、邱文祥1,2
馬偕紀念醫院泌尿科1；陽明醫學院2
Robotic-assisted bladder diverticulectomy: Case report
Li-Chen Chen1, Wun-Rong Lin1, Marcelo Chen1, Allen W. Chiu1.2
1Department of Urology, Mackay Memorial Hospital;
2School of Medicine, National Yang-Ming University
Cases:
A 75-year-old man presented with painless gross hematuria and UTI. Kidney-Ureter-Bldder (KUB) and renal echo showed nonspecific findings. Fiberocystoscopy showed a huge diverticulum over left lateral wall with left ureteral orifice inside. There was no urethral stricture or bladder trabeculation. The prostate size was 26 cm3. Abdominal computed tomography (CT) revealed a 22x12x13 cm diverticulum at left posterior side of bladder. The prostate size was 38 cm3. He underwent RABD 2 weeks later. The operative time was 430 minutes. Blood loss was 10 ml. He was discharged on post-operative day (POD) 10 without complications. The post void residual (PVR) was 56 ml after 3-year follow-up. The second patient was a 60-year-old man complained of urinary frequency for 6 months. The prostate size was 18 cm3. Abdominal CT revealed 2 bladder diverticula at right and left lateral wall of bladder. He underwent RABD for much residual urine (384-712 ml) and recurrent UTI. The operative time was 246 minutes. Blood loss was 30 ml. He was discharged on POD 4 without complications. The PVR was 64 ml after 2-month follow-up. We used extravesical approach transperitoneally in both cases.
Discussion:
Bladder diverticulum can be classified into acquired and congenital. Acquired bladder diverticulum is usually associated with bladder outlet obstruction. Congenital bladder diverticulum is found in smooth bladder surface and is not associated with bladder trabeculation. Most bladder diverticula are most clinically insignificant. Surgical management is indicated in LUTs, recurrent urinary tract infection (UTI), stone formation, malignancy and upper urinary tract deterioration. Surgical techniques include open, endoscopic, laparoscopic and robotic surgery. Porpiglia et al. reported that laparoscopic bladder diverticulectomy provided decreased blood loss and postoperative analgesic requirement, and shorter hospitalization compared with open surgery. De Castro Abreu et al. reported similar perioperative outcomes in RABD compared to laparoscopic bladder diverticulectomy. RABD has the benefit of minimal invasive procedure and is safe with low risk of perioperative complications. The PVR also improves after the surgery. In our patients, the blood loss was low intraoperatively and there was no major perioperative complications. The PVR reduced after the surgery.